Migraine and Echocardiography

The migraine patient may present with aura without headache,
occasionally mimicking a transient ischemic attack. The unilateral
sensory loss, hemiparesis, or dysphasia may prompt referral to
echocardiography to rule out a cardiac source of embolus.

The following references discuss a possible pathophysiological relationship
between migraine and mitral valve prolapse:

Pfaffenrath V, Pollmann W, Autenrieth G, Rosmanith U. Mitral
valve prolapse and platelet aggregation in patients with
hemiplegic and non-hemiplegic migraine.
Acta Neurologica Scandinavica 75(4):253-7, 1987 Apr.
Migraine and mitral valve prolapse (MVP) share a number of
features. Both migraine and MVP show platelet dysfunctions and an
increased risk of transient ischemic attacks (TIA) and stroke.
There is a strikingly high incidence of migraine among MVP
patients. The focal neurological deficits associated with
hemiplegic migraine resemble TIA symptoms which may occur in MVP
patients. Furthermore, the risk of cerebral infarction in
migraineurs is reported to be higher than in the general
population. The results of this study with 43 patients suffering
from non-hemiplegic migraine (common and classical migraine) and
19 migraineurs with a hemiplegic migraine indicate that
hemiplegic migraine is not associated with MVP and increased
platelet aggregation more frequently than other migraine forms.
Independent of migraine type, there is no difference between
patients with and without mitral valve prolapse with respect to
platelet dysfunction.

Spence JD, Wong DG, Melendez LJ, Nichol PM, Brown JD. Increased
prevalence of mitral valve prolapse in patients with
migraine.
Canadian Medical Association Journal 31(12):1457-60, 1984 Dec 15
Patients with classic migraine (69 women and 31 men)selected
randomly from a practice list of over 1000 were matched for age,
sex and neighbourhood with 100 people who did not have headache
problems, and both groups underwent M-mode and two-dimensional
echocardiography and clinical examination by cardiologists
blinded to the subjects' clinical status. The mean ages were 34.9
+/- 11.3 years for the migraine group and 33.1 +/- 9.9 years for
the control group. Definite and possible mitral valve prolapse
(MVP), diagnosed according to predefined echocardiographic
criteria, were found about twice as often in the migraine group
as in the control group in 15 v. 7 and 16 v. 8 patients
respectively); the
echocardiograms
were definitely normal in 69 migraine patients and 85 controls
(chi 2 = 8.39, p less than 0.025). Altogether 25% of the migraine
group and 11% of the control group had evidence of MVP from a
combination of the echocardiographic and auscultatory findings
(chi 2 = 5.72, p less than 0.025). The odds ratio was 2.7, with
95% confidence limits of 1.17 and 6.29. The association between
migraine and MVP has implications for the understanding of
platelet abnormalities and episodes of cerebral ischemia
occurring in both these conditions.

Litman GI, Friedman HM. Migraine and the mitral valve prolapse
syndrome.
American Heart Journal 96(5):610-4, 1978 Nov.
The authors of this 1978 article believe there is a significant
association between migraine and the mitral valve prolapse.
Propranolol is proposed as the drug of choice in these patients for the
treatment and prevention of migraine. Increased platelet aggregability
is postulated to be the common pathophysiologic mechanism as
relates to emboli from the valve and possibly in strokes related to
migraine.